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SGO 2019: Brachytherapy Boost Added to EBRT and Chemotherapy in Advanced Cervical Cancer

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Key Points

  • Approximately 75% women in the study also received brachytherapy boost, or internal radiation therapy, in addition to external-beam radiation and chemotherapy; about half received the boost within the recommended time frame of 8 weeks. The overall survival for the latter was significantly higher than all other groups.
  • Women who received brachytherapy boost beyond the recommended time frame of 8 weeks also experienced improved overall survival over women who received only external-beam radiation and chemotherapy.
  • Another study found black women were significantly less likely than white women to receive brachytherapy boost as part of their treatment for locally advanced cervical cancer—even though black women who received brachytherapy within the recommended time frame had survival rates similar to white women.

A recent National Cancer Database study has shown the current standard of care for advanced cervical cancer—external-beam radiation and chemotherapy in combination with brachytherapy—provides significantly higher overall survival over chemoradiation alone. However, the addition of brachytherapy has declined in the United States since the 1980s, and racial disparity exists among women being treated for locally advanced cervical cancer. These findings were presented by Korenaga et al at the Society of Gynecologic Oncology’s (SGO) 50th Annual Meeting on Women’s Cancer (Abstract 10).

Study Methods and Findings

A study presented by Travis-Riley Korenaga, MD, of the University of California, San Francisco (UCSF), identified more than 10,000 women diagnosed with locally advanced cervical cancer in the United States between 2004 and 2015. All women had been treated primarily with external-beam radiation and chemotherapy. Approximately 75% of these women also received brachytherapy boost, or internal radiation therapy; about half received the boost within the recommended time frame of 8 weeks. The overall survival for the latter was significantly higher than all other groups.

Women who received brachytherapy boost beyond the recommended time frame of 8 weeks also experienced improved overall survival over women who received only external-beam radiation and chemotherapy. This demonstrates, said Dr. Korenaga, that brachytherapy boost is associated with higher overall survival—regardless of treatment duration.

“Our study reminds us that brachytherapy is an important facet of treatment for locally advanced cervical cancer,” said the study’s senior author, Lee-may Chen, MD, also of UCSF. “We encourage early and more frequent referrals to radiation oncology, specifically to experienced brachytherapy providers.”

Care Disparities

Studies conducted as early as the 1970s show that brachytherapy improves outcomes for women undergoing treatment for advanced cervical cancer. However, additional studies show that brachytherapy use has been declining since the 1980s, possibly due to the high level of expertise required for the procedure as well as limited access to care.

Another study (Abstract 11) presented at the SGO Meeting by Stephanie Alimena, MD, and Martin T. King, PhD, MD, showed that black women were significantly less likely than white women to receive brachytherapy boost as part of their treatment for locally advanced cervical cancer—even though black women who received brachytherapy within the recommended time frame had survival rates similar to white women. This study of more than 15,000 women also revealed that black women, women over the age of 70, and women without health insurance or who received government-funded health care were significantly less likely to receive the boost within the recommended timeframe.

“Health-care disparities are a global phenomenon,” said Dr. King, of Brigham and Women’s Hospital and Dana-Farber Cancer Institute, “especially for a vulnerable population such as patients with cervical cancer. I think greater awareness may lead to funding for patients and get them into treatment faster.”

Disclosure: The study authors' full disclosures can be found at sgo.confex.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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